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APPLICATION FOR SANITATION PERMIT Permit No. ..�..[_____________ <br /> � (Complete in Duplicate) <br /> Date issued -�.�s�S3-• <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOBADDRESS AND LOCATION------------ 348- W�--a'hh--------------------•--•------------------------------------------•---------------••----------------- ------------: <br />' Owner's Name---------D031--F 1tOY1-------------------•------- --------------- -------------------------------------------- Phone----6_-6-2-77---•-----••---- <br /> same ------------------------------------ <br /> Address----------•------------ ...------ -•--------•------------------------•-•-------------------•------------------- ---- <br /> , <br />+ 1 1 � w <br /> ----------------------------------------------•----------------------- Phone----•----3'x-39.53----------- <br /> Contractor s Name--•------..-D.�1_�.�,-r---SI�.4.----•-•• ----•------------- ; <br /> Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _1_-__ Number of bedrooms ____2_ Number of baths ____1 Lot size __3_0_0X200--.----------------------------- ----- <br /> Wafer Supply: Public system ® Community system ❑ Private ❑ Depth to Water Table -25- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe f] Hardpan ❑ <br /> Previous Application Made: Yes ❑ No K] New Construction: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Ij <br /> Septic Tank: Distance from nearest well_________________Distance from foundation-------------------Material._____-__________- ______.___-:_______-._. <br /> EX S=IbTG No. of compartments---------- ---------------Size-------------------------------Liquid depth--------------------------Capacity----------------------- <br /> Disposal Field: Distance from nearest well-------__--------Distance from foundation_--______________-.Distance to nearest lot line----------------- <br /> EXIOTT_iiTG Number of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- <br /> Type of filter-material-------------------------Depth of filter material-.--------------------Total length------------------------------------------ <br /> l Seepage Pit: Distance to nearest well-____&O--.________Distance from foundation- -�__.--.Distance to nearest lot line----- -!------- <br /> Number of/fp its---------1-----------Lining materialhr$-,1:-------.Size: Diameter--------3......-.....Depth_--------15----------------- � <br /> Cesspool: Disfance'from nearest well----------------- from foundation--------------------Lining materisal--------------------'-----.-------__ <br /> ----Depth-------------------- --- Liquid Capacity ----- els. <br /> ❑ Size:.Diameter--------- ------------------- 9 p tY 9 { <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-------------------------------------- <br /> ❑ Distance to nearest lot line----------------- ------------------------------------------------- --------------------------------------- 1 <br /> Remodeling and/or repairing (describe)_----------------Ve-r-'I;-.----------_ e&ot cc - ~ <br /> ------------ ----------------- -- <br /> �`� a <br /> v-------fj'er �` ----- --- . <br /> >-------------------------------------------------------------- <br /> ---------- i <br /> ------- ------------------------- - <br /> -------------------------- I <br /> . I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)--------- D.Q1t?.•s----TnQ------------------------------ ------------------------------------------------------ ---------(Owner and/or Contractor) <br /> By:----------- ---------- --------�,'_erry---Var-thann-------------------------------•-----------------------(Title)-----Gen --11sr-•------------------------ ------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> t <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------------- ----------- - ------ '-------------------------------------- DATE---------------7------ "5 <br /> k - ._.. ._ -- � - "T . <br /> IREVlEiWED BY------ ------------------------------------- -----------=---------------------------------------------- --------- DATE - --- ---- <br /> ( BUILDING PERMIT ISSUED-------------------------- •---------------------------------------------------------- DATE <br /> i Alterations and/or recommendations------------------------------ ------•-------------------••----------•-----••--••------------------------------------------------------•--- <br /> ---------- ----------- ----------------------------------------------------- -•---------------------------------- <br /> ------------------------------------------------ ------------------------------------------- --------------------------- ---------------------------- <br /> ------------------------------­_­------------------ ---------------------------------------- ---------------------------- <br /> --------7 ------------------------3 <br /> FINAL INSPECTION BY:.. a� (.-. '` F Date <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT f <br /> 't <br /> 130 South American S+reef 300 West Oak Street 132 Sycamore Street 814 Nor+h "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> r:1 <br /> �-c <br /> ES-9-2M 10-52 Revised W-2100 <br />